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Thyroid Nodules

Topic Overview

What are thyroid nodules?

Thyroid
nodules are growths or lumps in the
thyroid gland in the front of your neck. This
gland controls how your body uses energy. Most thyroid nodules are not cancer
and do not cause problems. Many don't even need treatment.

Sometimes a thyroid nodule can cause problems. Sometimes a nodule can
make too much
thyroid hormone. When a nodule makes too much hormone,
the rest of the gland is suppressed and doesn't work as hard as
usual.

Most thyroid nodules are not cancerous. But if tests show cancer, surgery will be done to remove the nodule.

What causes thyroid nodules?

It is not clear what causes thyroid nodules. But
people who have been exposed to radiation have a greater chance of getting
them. Thyroid nodules are more common as you age. Also, the nodules tend to run in families. So if your parents had thyroid
nodules, you are more likely to have one.

What are the symptoms?

Most thyroid nodules are so small that you
don't even know you have one.

If you have a big nodule, you may
be able to feel it, or you may notice swelling in your neck. It's possible that
you may also:

Feel pain in your throat or feel like your
throat is full.

Have a hard time swallowing.

Have
trouble breathing.

Feel nervous, have a fast heartbeat, sweat a
lot, or lose weight. These are symptoms of
hyperthyroidism, where the thyroid gland makes too
much thyroid hormone.

How are thyroid nodules diagnosed?

Most people don't find thyroid nodules on their own,
because the nodules aren't easy to feel and don't usually cause symptoms. Your
doctor may have found a nodule on your thyroid when you were having a
CT scan or
ultrasound for another reason. Your doctor will do a
physical exam and will ask you if you have symptoms or any changes in how
you've been feeling.

You may have tests to see how well your
thyroid is working and to make sure the nodule is not cancer. Possible tests
include:

A blood test to check the level of thyroid
hormone in your body.

A thyroid scan, which uses
radioactive material and a camera to see how well your
thyroid gland is working. This is done if the level of thyroid hormone is high.

Fine-needle aspiration, which removes a small amount of material from the nodule. The material is checked for cancer cells.

Thyroid ultrasound, to see the number and size of nodules or
to locate the nodule for fine-needle aspiration.

How are they treated?

If your nodule is not cancer (benign) and is not causing
problems, your doctor will watch your nodule closely for any changes. But if the nodule is large or causing problems with swallowing or breathing, you'll need surgery to remove the nodule.

If your
thyroid nodule is causing hyperthyroidism, your doctor may recommend a dose of
radioactive iodine, which usually comes in a liquid that you swallow. Or your
doctor may have you take medicine (antithyroid pills) to slow
down the hormone production. In some cases, surgery may be done to remove an overactive thyroid nodule.

If your nodule
is cancer (malignant),
you'll need surgery to remove the nodule. You may also need treatment with
radioactive iodine to destroy any leftover cancer cells. After surgery, you may
need to take thyroid medicine for the rest of your life.

Cause

Experts don't know the exact cause
of
thyroid nodules. But they do know that people who have
been exposed to radiation have a greater chance of developing thyroid nodules.
Exposure to environmental radiation or past
radiation treatment to the head, neck, and chest
(especially during childhood) raises your risk for thyroid nodules. Thyroid nodules are more common as you age.

Experts know that thyroid nodules run in families. This means you are
more likely to have a thyroid nodule if one of your parents has had a thyroid
nodule.

Also, if you have another thyroid condition (such as
goiter), you may have a greater chance of developing
thyroid nodules.

Symptoms

Most
thyroid nodules do not cause symptoms and are so small
that you cannot feel them. They often are found during a physical exam or when
another test, such as a
CT scan or
ultrasound, is done for a different reason.

If your thyroid nodule is big, you may be able to feel it or you may
notice that your neck is swollen. In rare cases, you may also:

Feel pain in your throat or feel like your
throat is full.

Have a hard time swallowing.

Have a
hard time breathing.

Feel nervous, have a fast heartbeat, sweat a
lot, lose weight, or have other symptoms of
hyperthyroidism (too much thyroid
hormone).

Feel tired or depressed, have memory problems, be
constipated, have dry skin, feel cold, or have other symptoms of
hypothyroidism (too little thyroid hormone).

What Happens

Most
thyroid nodules do not cause problems and are not
cancerous. They are often hard to notice because they are so small. Lots of
people have thyroid nodules that are never found or treated.

There are three kinds of thyroid nodules: solid nodules, nodules that are
filled with fluid (cystic nodules), and nodules that are partially cystic. You
can have one thyroid nodule or several thyroid nodules (multinodular
goiter). You can also have some nodules that are solid
and some that are cystic. Solid nodules may grow slowly over time. In rare
cases, cystic nodules bleed, which can cause them to grow suddenly and become
painful.

Thyroid nodules usually do not prevent the
thyroid gland from doing its job. But sometimes a noncancerous thyroid nodule
can cause:

Hyperthyroidism. Hyperthyroidism happens when one or
more nodules make too much
thyroid hormone. Hyperthyroidism is treated with
antithyroid medicine, possibly radioactive iodine, and very rarely, surgery.
Hyperthyroidism from thyroid nodules is not very common.
For more information on treating hyperthyroidism, see the topic
Hyperthyroidism.

Difficulty breathing or
swallowing. Sometimes, one or more large nodules can press on your windpipe
(trachea) or on your
esophagus. These kinds of nodules have to be
surgically removed.

About 5 to 10 out of 100 thyroid nodules are cancer.1Thyroid cancer is
usually diagnosed and treated early, so most people do very well. For more
information, see the topic
Thyroid Cancer.

What Increases Your Risk

You are more likely to
develop a thyroid nodule if:

You are older. Thyroid nodules are more common
in older people.

You are female. Women are more likely than men to
develop thyroid nodules.

You have been exposed to radiation.
Exposure to environmental radiation or past
radiation treatment to your head, neck, and chest
(especially during childhood) increases your risk for thyroid nodules.

You do not get enough iodine. Iodine deficiency is rare
in the United States, but it is common in areas where iodine is not added to
salt, food, and water. An iodine deficiency may result in an enlarged thyroid
gland (goiter), with or without nodules.

You have
Hashimoto's thyroiditis. Hashimoto's thyroiditis can
cause an underactive thyroid gland (hypothyroidism).

One or both of your parents have had thyroid nodules.

When To Call a Doctor

Call your doctor if you have
any of these signs of
thyroid nodules:

Swelling in your neck for more than 2
weeks

A hoarse or scratchy voice that is not caused by a cold or
throat infection and lasts longer than 1 month

A hard time
swallowing

Symptoms of a thyroid problem, such as feeling tired,
weak, or nervous; losing weight; having trouble sleeping; or having a fast
heartbeat

If you have had part of your
thyroid gland removed because of noncancerous thyroid
nodules, you will need regular medical checkups to make sure your thyroid gland
is working well.

Who to see

Different types of health
professionals can help treat a thyroid problem.

Exams and Tests

The first step in diagnosing
thyroid nodules is a
medical history and
physical exam. Thyroid nodules often are found during
a physical exam or during a
CT scan or
ultrasound of the neck, chest, or head done for
another problem. Most people do not find thyroid nodules on their own, because
they are difficult to feel and usually do not cause symptoms.

If
your doctor finds a thyroid nodule, he or she may refer you to an
endocrinologist for more tests and treatment.

Fine-needle aspiration guided by ultrasound. Material that is removed from the nodule is checked for cancer cells. This is a simple procedure that can be done in your doctor's office.

Thyroid ultrasound. Ultrasound uses reflected sound waves to create a picture of
organs and other structures inside your body. Ultrasound cannot show whether a
nodule is cancerous, but it can help your doctor:

Confirm that you have thyroid nodules if
other tests have not been clear.

See what is happening to nodules
that are not going away.

Find your nodule during a thyroid biopsy with a
fine-needle aspiration.

Calcitonin
test. This test checks your level of a hormone called calcitonin as a way to
help find out if you have cancer. This test will probably be done if other
people in your family have had thyroid cancer or any other type of cancer of
the
endocrine glands.

Thyroid scan.
This test uses radioactive material and a camera to see how well your thyroid
gland is working and to see if you have
hyperthyroidism.

Ongoing exams

If your
nodule is not cancerous, your doctor will see you regularly to monitor the size of your nodule. He or she
may do other tests, such as checking your
thyroid-stimulating hormone (TSH) levels or doing a thyroid
ultrasound. If your nodule grows, other tests or surgery may be needed.

If
your thyroid gland was removed because of cancer, your doctor may test for
thyroglobulin, a protein made by both normal and cancerous cells. High levels
of thyroglobulin may mean that the cancer has spread (metastasized) to other
parts of your body.

Treatment Overview

Your treatment will depend on how
your
thyroid nodule affects you. If your thyroid nodule is
not cancerous (benign) and is not causing any problems, your doctor will watch
the nodule closely before doing anything else. If your thyroid nodule is
causing problems, you may need to take medicine or have surgery.

Antithyroid medicine and radioactive iodine can treat benign nodules that
are causing your thyroid gland to make too many hormones (hyperthyroidism). For more information on
hyperthyroidism, see the topic
Hyperthyroidism.

Surgery is usually only
necessary if your thyroid nodule is so large that it causes problems with
breathing or swallowing or if your nodule is cancerous. After a cancerous
nodule is surgically removed, you may need radioactive iodine to destroy any
thyroid tissue or cancer cells that are still causing problems. If you need to
have your entire thyroid gland removed, you will need to take thyroid hormone
medicine for the rest of your life.

For information about thyroid
cancer and its treatment, see the topic
Thyroid Cancer.

Initial treatment

When you know you have a
thyroid nodule, your treatment options include:

Observation. If your
thyroid nodule is not cancerous, your doctor may choose to check it every 6 to
12 months for changes in size. Many noncancerous thyroid nodules stay the same
size or shrink without treatment.

Surgery (thyroidectomy).
Not all thyroid nodules need surgery. You will need to have surgery to remove
part or all of your thyroid gland if:

Your nodule is cancerous or suspected to
be cancerous.

Your nodule is so big that it makes it hard for you
to breathe or swallow.

Your nodule is noncancerous but is making
too much thyroid hormone, causing
hyperthyroidism. If you have hyperthyroidism because
of your nodule and you are pregnant, it is not a good idea to have radioactive
iodine treatment. Your doctor may recommend surgery instead of radioactive
iodine.

You have several nodules (multinodular
goiter) and surgery is not a good idea because of
other health problems you have. Radioactive iodine can shrink nodules that
cause problems with breathing or swallowing, but your nodules may come back
after treatment.

Ongoing treatment

If
part or all of your thyroid gland needs to be surgically removed because of
cancer,
radioactive iodine may be used to destroy any thyroid
tissue or cancer cells that remain after surgery.

If you have a thyroid
nodule:

Take any thyroid hormone medicine your doctor
prescribes at the same time each day and do not miss a dose.

Call your doctor if you have symptoms of
hyperthyroidism, such as feeling nervous, having a
fast heartbeat, sweating more than usual, and losing weight. Sometimes,
hyperthyroidism develops from taking thyroid hormone medicine or when a
noncancerous nodule starts making too much thyroid hormone.

Call
your doctor if you have symptoms of
hypothyroidism, such as feeling tired, feeling cold
when others do not, and gaining weight. Hypothyroidism can develop after you
are treated with radioactive iodine or you have surgery.

Schedule regular checkups with your doctor. Even noncancerous
nodules need to be looked at by your doctor on a regular basis.

Treatment if the condition gets worse

If your
thyroid nodule gets bigger, your doctor may recommend
another
fine-needle aspiration to see whether the nodule has become
cancerous. If your nodule has become cancerous or appears to be cancerous, your
doctor will probably recommend surgery (thyroidectomy)
to remove some or all of your thyroid gland. You may also need
radioactive iodine.

Prevention

Thyroid nodules
cannot be prevented.

The American Thyroid Association recommends that all adults be tested beginning at age 35 and continuing every 5 years.2 But after reviewing all of the research, the U.S. Preventive Services Task Force (USPSTF) has not recommended for or against routine thyroid testing.3 Some other groups suggest that people who are high-risk—women older than 60 and anyone who has a family history of thyroid disease or who has other autoimmune diseases—may want to be screened.4 Talk to your doctor about whether you need to be tested for thyroid problems.

Home Treatment

Most
thyroid nodules aren't cancerous. Many thyroid
nodules don't need medical treatment. If you have a thyroid nodule that is
being watched, schedule regular medical checkups to see whether there are any
changes.

If you have had surgery to remove your thyroid gland, it
is important to:

Take your medicine at the same time each day
and do not miss a dose.

Follow your doctor's directions if you miss a dose.

Call your doctor if
you have symptoms of
hyperthyroidism, such as feeling nervous, having a fast
heartbeat, sweating more than usual, and losing weight.

Ask your
doctor or pharmacist if your thyroid medicine can be safely mixed with other
prescription or nonprescription medicines you take.

If you have had radioactive iodine treatment for thyroid
nodules, call your doctor if:

You have neck pain. This may mean your thyroid
gland is swollen.

You have symptoms of
hypothyroidism, such as feeling tired, feeling cold
when others do not, and gaining weight.

Medications

Radioactive
iodine is sometimes used to treat
hyperthyroidism in people who have noncancerous
thyroid nodules.

What to think about

If a nodule is noncancerous
but is producing too much thyroid hormone, causing
hyperthyroidism, antithyroid medicines may be used
before radioactive iodine treatment. For more information on treating
hyperthyroidism, see the topic
Hyperthyroidism.

Surgery

Surgery (thyroidectomy) is the best treatment for
thyroid nodules that are:

Cancerous (malignant).

Suspected
to be cancerous.

Noncancerous (benign) but large enough to cause
problems with breathing or swallowing.

People who develop thyroid nodules after receiving
radiation treatment to the head, neck, or chest are
more likely to need surgery because their risk for developing thyroid cancer is
greater. But most nodules in people who have had radiation therapy are not
cancerous.

For information about thyroid cancer and its
treatment, see the topic
Thyroid Cancer.

It is not clear how well
thyroid-stimulating hormone suppression therapy works to shrink noncancerous
thyroid nodules. If you have a noncancerous nodule, talk to your doctor about
whether TSH suppression therapy is right for you.

TSH suppression
therapy can raise your risk of heart and bone problems, especially if you have
heart disease or
osteoporosis. If you have heart disease, this kind of
medicine can make chest pain or problems with your heart rhythm worse. It can
also raise your chances of
heart attack. If you have osteoporosis, TSH
suppression therapy can further weaken your bones.

What to think about

Hypothyroidism (too little thyroid
hormone) occurs in some people after being
treated with radioactive iodine for thyroid nodules.
For this reason, your doctor will check your thyroid hormone levels regularly
after you have this treatment.

If a thyroid nodule is not
cancerous but is making too much thyroid hormone, causing
hyperthyroidism, antithyroid medicines may be used
before radioactive iodine treatment. For more information on treating
hyperthyroidism, see the topic
Hyperthyroidism.

Other Places To Get Help

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Suite 900

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Phone:

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Web Address:

www.hormone.org

The Hormone Health Network is a nonprofit organization
started by the Endocrine Society. The organization promotes the prevention,
treatment, and cure of hormone-related conditions through public outreach and
education.

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